扩张期肥厚型心肌病16例患者心脏再同步化治疗的临床特征及疗效分析

Clinical Features and Outcomes of Cardiac Resynchronization Therapy in 16 Patients With Dilated-phase Hypertrophic Cardiomyopathy

目的:回顾性分析16例接受心脏再同步化治疗(CRT)的扩张期肥厚型心肌病患者的临床特征及疗效。方法:2007-03至2016-01期间16例符合适应证的扩张期肥厚型心肌病患者在阜外医院接受CRT,回顾性分析其临床特征及疗效。结果:16例患者中,男性12例,女性4例;平均年龄(53.3±13.5)岁;术前心电图平均QRS时限为(158.7±32.2)ms;左心室射血分数(LVEF)为(33.6±6.3)%;纽约心脏协会(NYHA)心功能分级Ⅰ~Ⅳ级的例数分别为1例、5例、8例和2例;新安装CRT装置者13例,升级者3例;合并心房颤动患者8例。平均随访(2.56±2.13)年,共5例患者死亡,其中3例死于心力衰竭,1例猝死,1例死于卒中。6个月随访时,7例患者对CRT有反应(定义为:NYHA心功能分级改善≥1级且LVEF绝对值提高≥5%);NYHA心功能分级从(2.69±0.79)级改善为(2.38±0.89)级(P=0.02);LVEF从(33.6±6.3)%提高到(40.03±9.83)%(P=0.01)。结论:符合CRT适应证的扩张期肥厚型心肌病患者中,心房颤动的患病率更高,传统起搏器或者埋藏式心律转复除颤器升级为CRT的患者较多。接受CRT的扩张期肥厚型心肌病患者总体预后较差,但仍有一定比例的患者对CRT有反应。

Objective： To analyze the clinical features and outcomes of cardiac resynchronization therapy （CRT） in patients with dilated-phase hypertrophic cardiomyopathy （DHCM）. Methods： A total of 16 DHCM patients received CRT in our hospital from 2007-03 to 2016-01 were retrospectively studied to analyze their clinical features and outcomes. Results： There were 12 male and 4 female patients at the mean age of （53.3±13.5） years. Pre-operative QRS duration of ECG was （158.7±32.2） ms, left ventricular ejection fraction （LVEF） was （33.6±6.3） %, the patient with NYHA class Ⅰ, Ⅱ, Ⅲ and Ⅳ were 1, 5, 8 and 2 respectively. 13 patients received new CRT device, 3 received upgraded device and 8 （50%） combining atrial fibrillation （AF）. The patients were followed-up for （2.56±2.13） years, 5 of them died including 3 of heart failure, 1 of sudden death and 1 of stroke. At 6 months follow-up time, 7 patients bad the response to CRT which was defined by the improvement of NYHA class≥1 and the absolute elevation of LVEF〉5%; NYHA class improved from （2.69±0.79） to （2.38±0.89）, P=0.02; LVEF increased from （33.6±6.3） % to （40.03±9.83） %, P=0.01. Conclusion： DHCM patients with CRT indication had the higher incidence to suffer from AF, those were more in patients with traditional pacemaker or ICD upgrading. DHCM patients with CRT had the poor general prognosis, while there was still certain proportion of patients had the response to CRT.